Telehealth in Urologic Oncology: Temporal Trends and Patient Characteristics in the United States.

OBJECTIVES: To better characterize population-level data on utilization trends, patient-level predictors, and downstream costs of telehealth use across GU malignancies using a national commercial insurance claims database. METHODS: We extracted bladder, kidney, prostate, and testis cancer outpatient claims from the Merative MarketScan database. Telehealth claims were flagged from 2010 to 2023 and multivariable modeling was used to identify patient-level factors. Weighted generalized linear models were used to compare twelve-month insurer-paid and out-of-pocket spending after telehealth or in-person new patient visits. Two time-range cohorts were analyzed: pre-pandemic (2010-2019) and pandemic-era (2020-2022). RESULTS: There were 85 237 telehealth visits, which represented 0.25% of GU oncology claims. Telehealth use reached 1.93% in 2020 and fell to 1.06% by 2023. Men (OR 1.4; p<0.001), patients in the West (OR 1.6; p<0.001), and those with non-PPO insurance (OR 1.2; p<0.001) were more likely to use telehealth; non-urban patients (OR 0.68; p<0.001) and those with higher comorbidity burden (OR 0.92; p<0.001) were less likely. Prostate and kidney cancer had the highest telehealth rates; bladder cancer had the lowest. New patient oncology visits initiated via telehealth had lower patient out-of-pocket (OOP) spending in the pre-pandemic (SR 0.49; p=0.011) and pandemic-era (SR 0.82; p=0.0001) cohorts. Insurer-paid spending was comparable. CONCLUSIONS: Telehealth use in urologic oncology varies by cancer type, location, and insurance. It may lower costs for patients, which warrants further investigation and policy investment.